Continuity of care for patients who transition between health care settings is vitally important for maintaining quality health care. Nursing home (NH) residents experience a high rate of hospitalizations, including those with chronic conditions such as atrial fibrillation (AFIB). High quality medication use across settings of care is a key component of care coordination. However, NH residents with AFIB are at risk for adverse drug events, as pharmacotherapeutic management of AFIB, especially the use of warfarin, can be problematic among older adults. The relationship between medication quality and transitions to the hospital in the NH AFIB population is unclear, as most research on medication continuity across care settings focuses on the transition of patients between the hospital and community. The objective of this application is to examine the relationship between quality of pharmacotherapeutic management and transitions between the NH and hospital among long-stay NH residents with AFIB. The proposed study has three specific aims: 1) To describe pharmacotherapeutic management of AFIB in the nursing home;2) To characterize changes in antithrombotic medication use surrounding transitions experienced by NH residents with AFIB;3) To determine the relationship between quality of AFIB medication use and hospital transitions among long-stay NH residents with AFIB. Analyses will be performed through linkage of the 2006-2009 Minimum Dataset with Medicare administrative claims and Online Survey Certification and Reporting data. The first two aims will use a cross-sectional cohort of NH residents with AFIB;
the third aim will use a nonconcurrent prospective cohort design with repeated measures. The research training program will support the development of expertise in analytic methods, specifically the cross-lagged panel model, that are new to the field of health services research. Training provided by this fellowship award will facilitate the applicant in adapting this method to address future questions regarding medication reconciliation between the hospital and NH. The proposed research on AFIB medication quality in NHs and the relationship between AFIB medication use and transitions addresses the mission and research priorities of the National Institute on Aging by focusing on AFIB, a chronic condition common among older adults, and by addressing the relationship between management of this condition and outcomes such as hospitalizations. Providing information on the potential bidirectional influences of medication quality and hospitalizations among NH residents will support the development of interventions that promote high quality continuity of care, especially with respect to pharmacotherapy, for NH residents moving across settings of care.

Public Health Relevance

Nursing home (NH) residents are at high risk for adverse drug events as well as care transitions such as hospitalizations. This study will explore the relationship between pharmacotherapeutic management of a trial fibrillation, a common condition among older adults, and transitions across care settings. Understanding this relationship will inform the development of efficient and appropriately placed interventions that improve coordination of care for NH residents who experience transitions, especially with respect to pharmacotherapy.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Predoctoral Individual National Research Service Award (F31)
Project #
1F31AG044091-01A1
Application #
8593426
Study Section
Special Emphasis Panel (ZRG1-F16-L (20))
Program Officer
Zieman, Susan
Project Start
2013-07-01
Project End
2014-06-30
Budget Start
2013-07-01
Budget End
2014-06-30
Support Year
1
Fiscal Year
2013
Total Cost
$30,552
Indirect Cost
Name
University of Maryland Baltimore
Department
Pharmacology
Type
Schools of Pharmacy
DUNS #
188435911
City
Baltimore
State
MD
Country
United States
Zip Code
21201